Are Family Physicians an Answer to VA's Primary Care Crisis?

In the wake of an escalating scandal involving the
Department of Veterans Affairs and the Veterans Health Administration, the AAFP
was the first physician organization to make specific recommendations to
President Obama and Congressional leaders about how they could facilitate the
use of civilian family physicians to enhance access to primary care services
for veterans.

Here's a look back at how the situation unfolded and
a look ahead at the important work that remains to be done.

In April, news of a “secret” waiting list at an
Arizona VA facility emerged in local media reports in that state, where
hundreds of sick vets were forced to wait for care. Dozens died while waiting.
In May, a Government Accountability Office (GAO) report(www.gao.gov) -- and subsequent media reports -- exposed the profound and systemic
deficiencies in care delivery, access and management within the VA, especially
regarding primary care and mental health services.

In a matter of days, the Secretary of Veterans
Affairs and two senior officials had resigned or retired, and the public, media
and Congressional outrage reached a fever pitch.

Staff in the AAFP Division of Government Relations
took note of the GAO report and began developing policy options that would
allow civilian family physicians to provide care to veterans. During the same
time period, several AAFP members raised concerns about the situation during
the annual summer meeting of the Academy's commissions.

Through a series of conversations and policy
discussions, AAFP leadership determined that we should communicate directly to
President Obama and Congress on how America’s family physicians could assist
in the short-term to alleviate backlogs in the VA system.

On June 3, the AAFP made specific recommendations to
President Obama and Congressional leaders regarding the use of civilian family
physicians to enhance veterans' access to primary care services. Those recommendations focused on four major
areas:

allowing
civilian physicians to order diagnostic tests and therapy services inside the
VA,

permitting
for the referral of veterans by civilian physicians to specialist inside the
VA, and

extending
federal tort claims act protections to civilian physicians.

Our letter was received positively and led to ongoing communications between the White
House and the AAFP.

Simultaneously, Congress moved quickly and developed
legislation that would immediately expand access to care for veterans and implement
systems changes to prevent similar failures from occurring in the future. The
AAFP worked to communicate quickly with legislators of the House and Senate to
advance our policy priorities and ensure their inclusion in the legislation.

A few weeks later, the AMA House of Delegates
approved a resolution calling on the AMA and the full house of medicine to
support policies similar to those advanced previously by the AAFP.

On June 10, the House approved legislation that
would invest $50 billion per year during the next decade to improve access and
quality within the VA system, including allowing veterans to access the
services of civilian physicians. The Senate approved similar legislation a day
later.

Given the rapid process, the AAFP determined that it
would be advantageous to further define and articulate our policy priorities, which were submitted to the House-Senate
Conference Committee June 23, a day before the committee began its work.

In addition to the policy recommendations in the Academy's
letters dated June 3 and June 23, we believe that the VA is fertile ground for
workforce development, including graduate medical education, and we are
advancing these ideas aggressively. Specifically, we are calling on the conference
committee to dedicate significant financial resources to the establishment of
family medicine, internal medicine and psychiatry training programs inside the
VA -- with or without an external academic partner. We believe that the VA has
untapped capacity to train family physicians and, at the same time, expand access
to primary care services. This is an idea that has support within the conference
committee, and we are working hard not only to build support for the concept,
but also to make the policy-political arguments for why they should invest
money to create this new VA program.

The legislative process slowed significantly during the Fourth
of July recess, but the AAFP’s efforts haven’t. The Academy's government relations
staff continues to conduct meetings with the legislators and staff of the conference
committee to advance the policies outlined in our written communications. We
have made this work a priority, and we are pressing to ensure that our policy
recommendations are included in the final VA reform legislation.

While nothing is certain in Washington, we are
fairly confident that the conference committee will conclude its work, and both
the House and Senate will approve a final bill, prior to the congressional
recess. Although partisanship is high in this election year, lawmakers from
both parties would like to avoid returning home in August and having to explain
why this scandal happened in the first place and why they haven’t demonstrated
leadership in correcting this national tragedy.

Wonk Hard

Merritt Hawkins has released its 2014 Review of Physicians
and Advanced Practitioner Recruiting Incentives(www.merritthawkins.com), and for the eighth consecutive year family physicians were No. 1 on the list.
The Merritt Hawkins report is illustrative of the rapid changes in our health
care system and the dominant role primary care physicians are playing and will
play in new delivery and payment models. Of the 3,158 searches conducted
between April 1, 2013 and March 31, 2014, 23 percent were for a family
physician. Internal medicine was second at 7 percent. Despite strong promotion
from the media and policy-makers, nurse practitioners were the focal point of
only 4 percent of searches, and physician assistants came in at 1 percent. A
majority of searches, 59 percent, were for positions in communities with populations
of less than 100,000 people -- just another demonstration of why graduate
medical education needs to be diversified away from urban academic health
centers.

The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.